Heart Attack Treatment

Treatment for people diagnosed with heart attack can be complex. This section on heart attack treatments should help you talk with your health care team about your treatment plan.

Be sure to voice any questions or concerns you may have.

Common heart attack types and treatments

The type of heart attack you had affects the treatments that your medical team will suggest. A heart attack happens when a blockage in one or more heart (coronary) arteries reduces or stops blood flow to the heart. This starves part of the heart muscle of oxygen.

The blockage might be complete or partial:

• A complete blockage of a heart artery is a “STEMI” heart attack or ST-elevation myocardial infarction (MI).
• A partial blockage is an “NSTEMI” heart attack or a non-ST-elevation MI.

Treatments differ for a STEMI versus NSTEMI heart attack, but there can be some overlap.

Hospitals use different ways to restore blood flow to the part of the heart muscle damaged during your heart attack. These can include one or more of the following:

• Clot-dissolving medications
• Balloon angioplasty and stenting
• Surgery 

Some U.S. hospitals are equipped to use a procedure called percutaneous coronary intervention (PCI), a procedure to open clogged heart arteries. If you are at a hospital able to perform PCI, you would be sent to an area called a “cath lab.” There, an angiogram can assess blood flow to your heart and show how well your heart is pumping. Based on the results of that procedure, you may be routed to one of three treatments:

• Medical therapy only
• PCI
• Coronary artery bypass grafting (CABG)

A hospital that is not equipped to perform PCI might transfer you to one that is. Or your health care team may decide to give you medication to break down the clot and restore blood flow. You might be given an angiogram. This imaging technique is used to see inside your arteries, veins and heart chambers. This may be followed by surgery to restore the blood flow in your heart.

If the health care team confirms you had an NSTEMI heart attack, they typically use one of two treatment strategies. Both may involve a procedure called cardiac catheterization to look at the inside of your heart:

• The ischemia-guided strategy  uses blood thinners to stop a blood clot from forming.
• The early invasive strategy starts with using blood thinners to stop a blood clot from forming. It might also proceed to other medical therapies , a PCI with stenting or CABG, followed by other post-hospital care.

Your health care team can explain the approach to your heart attack treatment. They can answer any questions you might have. 

Types of medications

Heart attack treatment involves a variety of medications. This list provides an overview of common types. You can also learn about cardiac medications in more detail.

Your health care team will suggest the best combination of medications for your situation.

• Anticoagulant: Also called blood thinners, these medications make it harder for clots to form and keep existing blood clots from getting larger.
• Antiplatelet agent: Keeps blood clots from forming by preventing blood platelets from sticking together.
• Angiotensin-converting enzyme (ACE) inhibitor: Relax and widen blood vessels. Makes it easier for the heart to pump blood.
• Angiotensin II receptor blocker: These medications relax and widen blood vessels, improving blood flow. This keeps blood pressure from rising.
• Beta blocker: Makes the heart beat slower and with less force, which lowers blood pressure.
• Cholesterol-lowering medications: Various medications can lower blood cholesterol levels, but statins are the best first course of action. When statins don’t work, or if a person has serious side effects from statin therapy, other drugs may be used.
• Clot busters: Thrombolytics or fibrinolytics help break up blood clots that block blood flow to the heart.
• Morphine: Used to relieve chest pain not affected by nitroglycerin.
• Vasodilator: Relaxes and widens blood vessels, which can reduce blood pressure. Makes it easier for the heart to pump blood.

Dual Antiplatelet Therapy (DAPT)

Some people are treated with two types of antiplatelet agents at the same time to prevent blood clotting. This is called dual antiplatelet therapy (DAPT). It can be used for people who have:

• Heart attacks
• Stents placed in their coronary arteries
• Coronary artery bypass graft surgery (CABG)

One antiplatelet agent is aspirin. Many people with coronary artery disease are treated with aspirin for the rest of their lives. A second antiplatelet agent, called a P2Y₁₂ inhibitor, is prescribed for months or years in addition to aspirin therapy.

The type of medication and length of treatment will vary based on your condition and other risk factors. The risks and benefits of DAPT should be discussed with your health care team.

If you had a heart attack and a coronary artery stent placed, or you are being treated with medical therapy (no stent  or surgery), in addition to aspirin, your health care team may prescribe a P2Y₁₂ inhibitor for 6-12 months. In some cases, it may be advisable to be on DAPT longer.

You may be prescribed one of the following:

• Clopidogrel
• Ticlopidine
• Prasugrel
• Ticagrelor
• Cangrelor

You will be prescribed the medication that is best for you, based on your risk of blood clots and bleeding. The choice of medication and treatment length will be determined in discussions with your health care professional.